Rotator Cuff Tear

Arthroscopic Rotator Cuff Repair

Many rotator cuff tears occur due trauma, such as falls, motor vehicle accidents, etc. These traumatic tears are usually best treated by early surgery. However, over 50% of rotator cuff tears occur without trauma, often as part of the aging process. As we age, we lose our hair, our bone density, and often a certain part of our rotator cuff. In patients under 60 years of age, or those who have a rotator cuff tear following trauma, the rotator cuff tear is probably not part of the aging process, and should be repaired. In patients over the age of 60 years who haven’t had significant trauma and who can elevate their arms above their heads, 50-82% of patients with rotator cuff tears may feel better by simply strengthening their rotator cuffs and the muscles about the shoulder blades. If 3 months of strengthening fails to provide good pain relief, a rotator cuff repair should be considered.

Almost all rotator cuff tears can be repaired arthroscopically. Compared to open surgery, arthroscopic rotator cuff repair is less painful, and leads to less stiffness and greater patient satisfaction.

I usually use 4-5 stab wounds (portals) to fix the rotator cuff arthroscopically. Over a few months these heal to the point where they are hardly noticeable.

Instruments are used to pass sutures through the torn rotator cuff to sew it up side-to-side. This is shown diagramatically and the photographically below.
Sutures are used to sew the rotator cuff back to itself.		The knot is then tied to close the tears.
Suture anchors, little harpoons with sutures attached to them, are then placed into the bone, so that the rotator cuff can be tied back down to the bone.
Instruments are used to shuttle the anchor’s sutures through the rotator cuff.
Knots are tied arthroscopically.		The rotator cuff tear is completed.